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Kuyler A, Heyns T, Johnson E. Critical care nurses' experiences of communication-vulnerable patients in the intensive care unit and the influence on rendering compassionate care. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2024; 40:e750. [PMID: 38989477 PMCID: PMC11232566 DOI: 10.7196/sajcc.2024.v40i1.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 07/12/2024] Open
Abstract
Background Interventions administered to critically ill patients, including mechanical ventilation, sedation or other treatments may hinder communication between patients and nurses. These communication challenges may affect critical care nurses' ability to provide compassionate, person-centred care. Objectives To identify nurses' experiences with patients who are communication-vulnerable in the intensive care unit and how they affect nurses' ability to offer compassionate care. Methods This qualitative explorative descriptive study involved nurses who worked in intensive care units from four private hospitals in Gauteng, South Africa. Focus groups were conducted with 30 critical care nurses in groups of two to six participants each. Thematic analysis was used to identify themes. Results Five main themes were identified based on nurses' reports of their experiences with critically ill patients who experience communication difficulties and their impact on rendering compassionate care. Themes were deductively identified based on the social purposes of communication categories. Participants indicated that communication-vulnerable patients influence their ability to provide compassionate care. Generally, the physical, emotional, social and communication difficulties of assisting communication-vulnerable patients caused nurses to feel frustrated and negative towards their work environment, which added to their work stress and sometimes resulted in compassion fatigue. Conclusion The study shows that various factors could impact the nurses' ability to provide compassionate care and that they require support to provide person-centred care. These factors can include the physical environment, the patient's alertness and awareness and institutional barriers. To support nurses in providing compassionate care, communication partner training may be warranted. Contribution of the study This study aims to increase awareness of the aspects that may contribute to compassion fatigue for nurses. By identifying these aspects greater support can be provided by facilities where nurses work.
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Affiliation(s)
- A Kuyler
- University of South Africa, Department of Inclusive Education, Pretoria, South Africa
| | - T Heyns
- Department of Nursing Science, University of Pretoria, South Africa
| | - E Johnson
- University of South Africa, Department of Inclusive Education, Pretoria, South Africa
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Zhong XF, Shorey S. Experiences of workplace violence among healthcare workers in home care settings: A qualitative systematic review. Int Nurs Rev 2023; 70:596-605. [PMID: 36580395 DOI: 10.1111/inr.12822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/24/2022] [Indexed: 12/30/2022]
Abstract
AIMS The aims of this systematic review were to obtain a comprehensive understanding of healthcare workers' experiences who were subjected to workplace violence in the home care environment and identify their specific support needs. BACKGROUND Workplace violence toward healthcare workers has been a prevalent and ongoing issue. With the expansion of home care services, more emphasis should be placed on maintaining a safe in-home care environment for healthcare workers. Understanding healthcare workers' experience of workplace violence is crucial for developing effective interventions. METHODS A systematic search was conducted in 10 databases from their inception date until January 2022. Primary qualitative studies were included. Two reviewers performed screening of studies, methodological quality assessment, and data extraction and analysis independently. The two-step approach by Sandelowski and Barroso on meta-summary and meta-synthesis was used. This qualitative systematic review was reported according to the PRISMA guidelines. RESULTS Eight studies were included. Three themes were identified: (1) impact of workplace violence, (2) reasons behind tolerating violence, and (3) way forward to prevent violence. CONCLUSION Workplace violence is common among healthcare workers in home care settings, yet the support provided to healthcare workers is inadequate. The findings suggest the need for effective interventions and policies to address this grave issue in order to improve the well-being of healthcare workers as it may indirectly affect the care quality provided to patients. IMPLICATIONS FOR NURSING Due to the unique nature of home care services, interventions preventing workplace violence must be tailored to the specific home care settings and needs of healthcare workers. Future research should develop and evaluate different interventions to prevent workplace violence in home care settings.
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Affiliation(s)
- Xiao Fan Zhong
- Nursing Division, National University Hospital, Singapore, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Singapore, Singapore
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Claesson M, Jonasson LL, Josefsson K. Next of kin's experiences of registered nurses' leadership close to older adults in municipal home care in Sweden: an interview study. BMC Nurs 2021; 20:213. [PMID: 34715871 PMCID: PMC8554742 DOI: 10.1186/s12912-021-00745-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background Next of kin to older adults over 65 years in municipal home care are concerned whether their older adults’ needs are being met. In municipal home care, the registered nurses’ leadership is important and complex, entailing multi-artist skills involving the older adults and their next of kin. Yet, little is known about next of kin’s experiences of registered nurses’ leadership. Thus, the aim of this study was to explore next of kin’s experiences of registered nurses’ leadership close to older adults in municipal home care. Methods Individual telephone interviews were conducted with next of kin (n = 11) of older adults from April to September 2020 in two municipalities in western Sweden. Data were analysed using qualitative content analysis. Results The results are presented with the theme, registered nurses do what they can, including two categories, interaction and competence, and the subcategories, relationship, communication, availability, responsibility, team leadership and cooperation. Registered nurses’ leadership was experienced as a balancing act between their commitments and what they were able to achieve. Conclusions Next of kin’s experiences of registered nurses’ leadership can contribute knowledge that will strengthen and prepare registered nurses for their leadership roles. This knowledge can support the development of policies for organisational preconditions that ensure quality and safe care to older adults in municipal home care.
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Affiliation(s)
- Maria Claesson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden.
| | - Lise-Lotte Jonasson
- Department of Nursing School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Karin Josefsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden.,Faculty of Health, Science and Technology, Department of Health Sciences, Karlstad University, Karlstad, Sweden
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Fjørtoft A, Oksholm T, Førland O, Delmar C, Alvsvåg H. Balancing contradictory requirements in homecare nursing-A discourse analysis. Nurs Open 2020; 7:1011-1019. [PMID: 32587719 PMCID: PMC7308681 DOI: 10.1002/nop2.473] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/27/2020] [Accepted: 02/16/2020] [Indexed: 11/11/2022] Open
Abstract
Aim To explore prevailing discourses on nursing competence in homecare nursing to boost understanding of practice within this field. Design A qualitative study with a social constructivist perspective. Methods Six focus-group interviews with homecare nurses in six different municipalities in Norway. Adapting a critical discourse analysis, data were linguistically, thematically and contextually analysed in the light of theories on competence, institutional logic and discourses. Results The analysis found homecare nursing to be a diverse and contradictory practice with ever-increasing work tasks. Presented as binary oppositions, we identified the following prevailing discourses: individualized care versus organizing work; everyday-life care versus medical follow-up; and following rules versus using professional discretion. The binary oppositions represent contradictory requirements that homecare nurses strive to balance. The findings indicate that medical follow-up and organizational work have become more dominant in homecare nursing, leaving less time and attention paid to relational and everyday-life care.
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Affiliation(s)
- Ann‐Kristin Fjørtoft
- Center of Diaconia and Professional PracticeVID Specialized UniversityOsloNorway
- Faculty of Health SciencesVID Specialized UniversityBergenNorway
| | - Trine Oksholm
- Faculty of Health SciencesVID Specialized UniversityBergenNorway
| | - Oddvar Førland
- Faculty of Health SciencesVID Specialized UniversityBergenNorway
- Centre for Care Research Western NorwayWestern Norway University of Applied SciencesBergenNorway
| | - Charlotte Delmar
- Faculty of Health SciencesVID Specialized UniversityBergenNorway
- Department of Nursing ScienceHealth FacultyInstitute of Public HealthAarhus UniversityAarhusDenmark
| | - Herdis Alvsvåg
- Faculty of Health SciencesVID Specialized UniversityBergenNorway
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Solli H, Hvalvik S. Nurses striving to provide caregiver with excellent support and care at a distance: a qualitative study. BMC Health Serv Res 2019; 19:893. [PMID: 31771566 PMCID: PMC6880571 DOI: 10.1186/s12913-019-4740-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 11/13/2019] [Indexed: 12/26/2022] Open
Abstract
Background In Norway, changes in life expectancy have led to increased attention to older people who are ageing at home, by means of home care services, adapted technology and informal caregivers. The caring situation has become difficult for many caregivers. The use of telecare has now offered them the possibility to receive support at home. The purpose of this study was to explore how nurses provide support and care at a distance, using a web camera and a web forum in a closed telecare network for caregivers to persons suffering from stroke and dementia. Methods The study had an explorative design with a qualitative approach. The data sources consisted of interviews with nurses and excerpts from posts in a closed telecare network. Content analysis was used to analyse the text from the interviews and the text from the web forum. Results The main theme, “Balancing asymmetric and symmetric relationships” described nurses’ relationship with caregiver. Two categories, “Balancing personal and professional qualities” and “Balancing caregivers’ dependence versus independence” were identified. The first describing the tension in their dialogue, the second describing how nurses provided the caregivers with a sense of security as well as strengthening them to master their daily lives. Conclusions The nurses provided long distance support and care for the caregivers, by using computer-meditated communication. This communication was characterized by closeness as well as empathy. To strengthen the caregivers’ competence and independence, the nurses were easy accessible and provided virtual supervision and support. This study increases the knowledge about online dialogues and relationship between nurses and caregivers. It contributes to knowledge about balancing in the relationship, as well as knowledge about bridging the gap between technologies and nursing care as potential conflicting dimensions. Maintenance of ethical principles are therefore critical to be aware of.
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Affiliation(s)
- Hilde Solli
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Porsgrunn, Norway. .,, Kongsberg, Norway.
| | - Sigrun Hvalvik
- Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Porsgrunn, Norway.,, Kongsberg, Norway
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Lotfi Fatemi N, Karimi Moonaghi H, Heydari A. Perceived Challenges Faced by Nurses in Home Health Care Setting: A Qualitative Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2019; 7. [PMID: 31041322 PMCID: PMC6456761 DOI: 10.30476/ijcbnm.2019.44883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Home care has gradually become a nursing model for nursing care. The nurses’ experiences of challenges they have in home care have remained unknown. The aim of this study was to explore the hidden aspects of challenges related to home care in Iran.
Methods: This study was conducted to explore the challenges of home nursing care using a qualitative content analysis method. Purposeful and snowball sampling methods were used for sampling. The study was conducted from September 2016 to September 2017 in the provinces of Khorasan and Tehran in Iran. Semi-structured interviews were conducted on 33 nurses who were providing home care. After data saturation, the data were analyzed.
Results: The data analysis led to the development of five main categories of “difficult instances “, “economic problems”, “professional barriers”, “social difficulties”, and “bureaucratic tension”.
Conclusion: The results of this study showed how nurses faced with a variety of challenges in home care and how they were different from hospitals. Facilitating the nursing processes, supporting home care, and recruiting nurses that had the potential to cope with the existing stressful factors and economic incentives can increase the quality of home care.
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Affiliation(s)
- Naser Lotfi Fatemi
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Karimi Moonaghi
- Evidence-Based Caring Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran;
,Department of Medical Education, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Evidence-Based Caring Research Center, Department of Medical Surgical Nursing, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Nursing staff's responses to thematic content of patients' expressed worries: observing communication in home care visits. BMC Health Serv Res 2018; 18:597. [PMID: 30075767 PMCID: PMC6091070 DOI: 10.1186/s12913-018-3390-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/13/2018] [Indexed: 02/07/2023] Open
Abstract
Background The aim of the study was to explore the thematic content of older persons’ expressed worries in home care visits, and how nursing staff respond to different thematic contents. Methods The study had a descriptive, observational design, including 195 audio-recorded Norwegian home care visits with 33 nursing staff and 48 older persons. In all, 638 patient cues/concerns (worries) and subsequent nursing staff’s responses were identified using Verona Coding Definitions of Emotional Sequences. A novel thematic coding scheme was used to label the thematic content of the cues/concerns. The nursing staff’s responses were grouped based on communicative function as emotion-focused, content-focused or ignoring/blocking the cue/concern. Group difference was analysed using Pearson’s chi-squared test, Fisher’s exact test, and adjusted residuals. Results The theme of worries was associated with elicitation of the cue/concern, either elicited by the nursing staff or spontaneously expressed by the patient (Chi-square, p< 0.001). “Ageing and bodily impairment” was the most common theme (66%) and was equally elicited by patients and nursing staff. Worries about “Relationships with others” (9%), “Health care-related issues” (15%) and “Life narratives and value issues” (9%) were mainly elicited by nursing staff. The nursing staff response was associated with the theme of worries (p˂0.001). For the sub-themes of “Ageing and bodily impairment”, Coping with existential challenges received more frequently emotion-focused responses (adjusted residuals: 3.2) and Expression of pain felt in the moment were more frequently ignored/blocked (adjusted residuals: 4.0, Fisher’s exact test, p< 0.001). For the sub-themes of “Relationships with others”, Being a burden more frequently received a content-focused response (adjusted residuals: 2.8), while Losing social ties more frequently received an emotion-focused response (adjusted residuals: 3.1, Fisher’s exact test, p = 0.009). Conclusion “Ageing and bodily impairment” was the most common theme and more frequently elicited by the older persons than other themes. Emotionally focused nursing staff responses were most common when addressing existential challenges and fear of losing social ties. Whereas nursing staff showed a tendency to ignore patients’ spontaneous expressions of pain. Further research should explore the influence of nursing staff’s responses on quality of care and patient satisfaction.
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Doi L, Jepson R, Hardie S. Realist evaluation of an enhanced health visiting programme. PLoS One 2017; 12:e0180569. [PMID: 28672013 PMCID: PMC5495393 DOI: 10.1371/journal.pone.0180569] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 06/16/2017] [Indexed: 11/19/2022] Open
Abstract
Background The health visitors’ role in many countries is changing. In Scotland, the role has undergone substantial changes through the introduction of an enhanced health visiting programme, which includes increased, structured home visits. This evaluation was conducted within NHS Ayrshire and Arran, one of the 14 Scottish Health Boards. Our aim was to understand and explain how, and why, the programme could contribute to improving health and wellbeing outcomes for children and families. Methods We used a realist evaluation approach, conducted in three phases. In phase one, eight managerial staff involved in developing and implementing the programme provided data, which were used to develop initial programme theories. In phase two, the programme theories were tested using qualitative data from 25 health visitors and 22 parents. The programme theories were refined through analyses and interpretation of data in phase three. Results The home visiting context provided by the programme interacted with the mechanisms of the programme and produced outcomes such as early identification of health and wellbeing issues amongst families who needed more support, leading to referral and engagement with sources of additional help. The home visits facilitated development of parent-health visitor relationships, and parents considered health visitors as their first point of contact on children’s wellbeing and developmental-related issues. Moreover, the programme provided more clarity to health visitors’ role, which in turn enhanced partnership working. However, there were aspects of the programme that may require further development. For instance, both parents and health visitors were concerned about the wide gaps between some home visits. Conclusions The enhanced health visiting programme increased opportunities for monitoring and early identification of health and wellbeing concerns. It created structures for a more efficient partnership working and ensured that the needs of children and families were supported. These benefits need to be evaluated further in an effectiveness study.
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Affiliation(s)
- Lawrence Doi
- Scottish Collaboration for Public Health Research and Policy, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Samantha Hardie
- School of Health and Life Sciences, Glasgow Caledonian, Glasgow, United Kingdom
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